Apparatus and method for real-time tracking of tissue structures

ABSTRACT

A method and system are disclosed for radiosurgical treatment of moving tissues of the heart, including acquiring at least one volume of the tissue and acquiring at least one ultrasound data set, image or volume of the tissue using an ultrasound transducer disposed at a position. A similarity measure is computed between the ultrasound image or volume and the acquired volume or a simulated ultrasound data set, image or volume. A robot is configured in response to the similarity measure and the position of the transducer, and a radiation beam is fired from the configured robot.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application claims priority to and is a continuation of U.S.application Ser. No. 14/854,274, filed Sep. 15, 2015, which claimspriority to and is a continuation of PCT/US2014/027367, filed Mar. 14,2014, which claims the benefit under 35 USC 119(e) of U.S. ProvisionalApplication No. 61/799,889 filed Mar. 15, 2013. The full disclosure ofwhich is incorporated herein by reference in its entirety for allpurposes.

This application is related to U.S. patent application Ser. No.11/971,399 filed on Jan. 9, 2008, and entitled “Depositing Radiation inHeart Muscle under Ultrasound Guidance,” the full disclosure of which isincorporated herein by reference.

FIELD OF THE INVENTION

The present invention generally relates to systems and methods fortracking anatomical targets using ultrasound. Optionally, embodiments ofthe present invention may be used in tracking anatomical targets duringa radiosurgical procedure.

BACKGROUND OF THE DISCLOSURE

Devices for medical imaging were originally invented for the purpose ofdiagnosis. Recently, devices for medical imaging have been used for morethan just diagnosis—medical imaging may now be used to visualize theanatomical site not only before, but also during an intervention. Inthis way, the intervention can be guided by the imaging device. In aradiosurgical system/procedure, image distortions in guidance imagesshould not be ignored since inaccuracies in the guidance images willlead to inaccuracies in the treatment.

Targets such as tumors in the head, spine, abdomen and lungs have beensuccessfully treated by using radiosurgery. During radiosurgery, thetarget is bombarded with a series of beams of ionizing radiation (forexample, a series of MeV X-ray beams) fired from various differentpositions and orientations by a radiation delivery system. The beams canbe directed through intermediate tissue toward the target tissue so asto affect the tumor biology. The beam trajectories help limit theradiation exposure to the intermediate and other collateral tissues,using the cumulative radiation dose at the target to treat the tumor.The CyberKnife™ Radiosurgical System (Accuray Inc.) and the Trilogy™radiosurgical system (Varian Medical Systems) are two such radiationdelivery systems.

Some systems also have an ability to treat tissues that move duringrespiration, and this has significantly broadened the number of patientsthat can benefit from radiosurgery. It has also previously been proposedto make use of radiosurgical treatments for treatment of other tissuesthat undergo physiological movements, including the directing ofradiation toward selected areas of the heart for treatment of atrialfibrillation. Modern robotic radiosurgical systems may incorporatein-treatment imaging into the treatment system so as to verify theposition of the target tissue without having to rely on rigid frameworksaffixing the patient to a patient support. Recently, ultrasound has beenproposed as a modality for tracking an anatomical target; however,ultrasound tracking for regions in the upper chest is difficult. Forinterventions in the heart, both respiratory and cardiac motion must beaddressed. In the case of radiosurgery, the therapeutic beam must followthe target with high accuracy.

While ultrasound tracking during radiosurgical treatments providebenefits by significantly reducing trauma for heart patients,improvements to existing systems and methods of ultrasound tracking maybe helpful to expand the use of ultrasound tracking during radiosurgicaltherapies.

In light of the above, it would be desirable to provide improveddevices, systems, and methods for tracking tissues using ultrasound andtreating tissues of a patient, particularly by directing radiation fromoutside the patient and into target tissues of a heart. It would beparticularly beneficial if these improvements were compatible with (andcould be implemented by modification of) existing radiosurgical systems,preferably without significantly increasing the exposure of patients toincidental imaging radiation, without increasing the costs so much as tomake these treatments unavailable to many patients, and/or withoutunnecessarily degrading the accuracy of the treatments and withoutcausing collateral damage to the healthy tissue despite the movement ofthe target tissues during beating of the heart.

SUMMARY OF THE DISCLOSURE

The following presents a simplified summary of some embodiments of theinvention in order to provide a basic understanding of the invention.This summary is not an extensive overview of the invention. It is notintended to identify key/critical elements of the invention or todelineate the scope of the invention. Its sole purpose is to presentsome embodiments of the invention in a simplified form as a prelude tothe more detailed description presented later.

The present invention generally provides improved systems and methods oftracking anatomical targets using ultrasound. Optionally, embodiments ofthe present invention may be used in tracking anatomical targets duringa radiosurgical procedure. The apparatus and method may also be used forcatheter ablation procedures as well. It can equally be used for anyother surgical intervention with or without robot assistance as well.For diagnostic purposes, standardized ultrasound views are defined fortwo goals: 1) to find an area of undisturbed line of sight to thetarget, and 2) to define a standardized view where a physician caneasily navigate and make his diagnosis. Trying to reach this secondgoal, limited imaging quality of the target region is often accepted.For tracking purposes, a standardized view is not necessary.

One difficulty for the every-day use of an ultrasound tracking system isfinding an optimal view from the transducer to the target offering ahigh quality ultrasound image. Obtaining high quality ultrasound imagesmainly depends on the tissue passed in the line of sight between theultrasound transducer and target. Further criteria for good imaging andtracking results are the distance between target and transducer and thetarget reflectivity according to the beam direction. While blood andmuscle tissue usually have good transmission characteristics, the ribsand the air inside the lung absorb or reflect nearly 100% of the emittedultrasound beam, virtually rendering visualization of the underlyingtissue impossible. Accordingly, high quality ultrasound of a patient'schest is difficult due to the presence of air and bony structures, anddue to image distortions in ultrasound.

Furthermore, tracking in radiosurgery comes with a couple of limitationswhich considerably increase the complexity of the ultrasound viewfinding problem. Some of the standardized transducer positions aregenerally not applicable during treatment. Patients are usually lying ontheir back to allow a stable registration to the planning-CT. Forultrasound visualization, patients are usually rotated to the side. Inthis position, the heart slightly falls in the direction of gravity andpresses against the lung, reducing the air between target and skin.Without rotation, these standardized ultrasound views may not even allowvisualization of the target. Moreover, target visibility over time is aproblem. Continuous target visualization has to be guaranteed for a fulltreatment session. Ultrasound images have a tendency to faint, so thecamera must be moved continuously by a human operator to keep up areadable image. Additionally, breathing commands to deflate the lung,resulting in an enhanced target visibility for a short time are notapplicable, as a stream of high quality images of the anatomical targetare needed throughout the therapy.

In accordance with one aspect of the invention, imaging quality of anultrasound transducer placed at a certain skin position is estimatedprior to obtaining ultrasound image data. The image quality may beestimated by analyzing the route from a transducer position to a chosentarget. The route information may be provided by image data from apreoperative imaging modality such as CT, x-ray, MRI, PET, etc. Based onthe preoperative images of the anatomical site, ultrasound velocity maybe estimated in each of the tissues disposed along the route from theposition of the transducer to the target. A virtual ultrasound beam maybe propagated through the tissues disposed along the route in thepreoperative image data using a ray casting method. Thereafter, theultrasound transmission between the position and target may be estimatedand displayed to an operator. A plurality of image quality estimates maybe calculated to determine a position with the highest estimatedultrasound quality. Additionally, ultrasound image quality may becalculated over a period of time for each position to determine how theimage quality may change with respiration and/or heartbeat movement ofthe patient. Further, once a desired ultrasound imaging position isdetermined and while acquiring ultrasound image data from the position,a distortion in the acquired image data may be compensated by analyzingthe route between the ultrasound transducer and the target in thepre-operative imaging data.

In accordance with another embodiment of the invention, an ultrasoundcamera is used to track a moving anatomical target, where the distortionof the ultrasound camera is compensated by observing a sequence ofpositions of the target or a surrogate of this target in another imagemodality. This second image modality may be configured to deliver imagesinfrequently or less frequently than the ultrasound camera, but may becalibrated in such a way that distortions remain small or negligible.The motion curves of the target resulting from both the ultrasoundsequence and the second image modality are then overlaid and acomputation is performed to subtract the distortion effects in theultrasound image sequence. Since ultrasound may deliver a stream ofimage data, with more than 20 images per second for example, the methodaccording to this embodiment of the invention will yield a stream oflow-distortion images. A method for analyzing the ultrasound images canthen be applied to obtain target position information on the preciselocation of the target during a treatment. For periods of poorvisibility, the in-treatment position can be inferred from the pastobservations through an extrapolation of the motion pattern in time,until the target will again become visible. Accordingly, respiratorymotion and cardiac motion can be addressed. The above methods may beincorporated individually or in combination with radiosurgical systemsand methods to provide target tracking with reduced patient exposure toradiation.

In some embodiments of the present invention, a method for providingultrasound image guidance data is provided. The method includes imagingan anatomical site including a target with an ultrasound camera togenerate a stream of ultrasound data of the anatomical site and imagingthe anatomical site with a second imaging modality to generate secondimaging data of the anatomical site. A target distortion may becompensated in the stream of ultrasound data with the second imagingdata of the anatomical site. The second imaging modality may generateintermittent second modality image data of the target less frequentlythan the ultrasound camera. For example, the second modality may be abi-plane x-ray imaging modality.

The step of compensating for distortion in the stream of ultrasound datamay include observing a time sequence of positions of the target or asurrogate of the target using the second imaging modality and developinga first motion curve of the target position from the stream ofultrasound image data and a second motion curve of the target positionfrom the second imaging modality data. The step of compensating fordistortion in the ultrasound data may further comprise deforming thefirst motion curve by overlaying the first motion curve with the secondmotion curve, computing the distortion in the stream of ultrasound imagedata based on the deformation of the first curve, and subtracting thedistortion from the ultrasound image data.

In some embodiments an in-treatment position of the target may beextrapolated based on past observations when an ultrasound cameravisibility of the target is below a threshold value. The extrapolationmay end when the ultrasound camera visibility of the target is above thethreshold value. In some embodiments, the method of compensating fordistortion may be used in a radiosurgical treatment of the heart totreat for arrhythmia, for example. Preferably, the method includesestimating ultrasound image quality at a plurality of positions prior toimaging the anatomical site with the ultrasound camera to thereby obtainhigh quality images of the target.

In other embodiments of the present invention, a method of increasingaccuracy and compensating for distortion in acquired ultrasound imagedata is provided. The method may include implanting a fiducial markernear a target at an anatomical site and acquiring image data of aposition of the fiducial marker with a first imaging modality atdiscrete intervals. Ultrasound image data of the fiducial markerposition may be acquired with an ultrasound camera. A first curve may befitted to the position data from the first imaging modality and a secondcurve may be fitted to the position data from the ultrasound camera. Thesecond curve is deformed by overlaying the first curve with the secondcurve and distortion from the ultrasound image data may be subtractedbased on the deformation of the second curve. Preferably, the methodincludes estimating ultrasound image quality at a plurality of positionsprior to imaging the anatomical site with the ultrasound camera.

In some embodiments of the invention, a system for compensating fordistortion in acquired ultrasound image data is provided. The systemincludes an input module configured to receive anatomical site imagedata from a first imaging modality over discrete intervals, theanatomical site image data comprising a position of a target or afiducial. The input module may be further configured to receive a streamof anatomical image data from an ultrasound transducer, the ultrasoundimage data including a position of the target or the fiducial. Thesystem may include a signal processing module coupled with the inputmodule which is configured to fit a first curve to the position of thetarget or fiducial in the first image modality data and a second curveto the position of the target or fiducial in the ultrasound image data.The signal processing module may deform the second curve by overlayingthe second curve with the first curve and remove distortion from theultrasound image data based on the deformation of the second curve.

Optionally, the system may include an extrapolation module coupled withthe input module and the signal processing module. The extrapolationmodule may be configured to extrapolate an in-treatment position of thetarget based on past motion when the ultrasound image visibility is low.In some embodiments, the input module may receive anatomical site imagedata from a second imaging modality. The system may also include animage quality estimation module coupled with the input module which isconfigured to estimate ultrasound image quality at a plurality ofpositions. The system may include a display coupled with the imagequality estimation module for outputting an indication of the ultrasoundimage quality at positions relative to the target as estimated by theimage quality estimation module.

In other embodiments of the invention, a method for determining adesired position for an ultrasound transducer is provided. The methodmay include acquiring image data of an anatomical site including atarget and estimating an image quality of the ultrasound transducer whenimaging the target from a position relative to the imaging target by atleast analyzing the acquired image data to estimate ultrasound velocityalong a route from the position to the target. The analyzed route maypass through one or more tissue types. The received image data maycomprise pre-operative CT image data for example and the route can beevaluated by classifying the route tissue types with their CT intensityvalues. Image quality of the ultrasound transducer may be estimated byvirtually propagating an ultrasound beam along the route and through theone or more tissue types using a ray casting method. Further, imagequality of the ultrasound transducer may be estimated by approximatingultrasound transmission at discrete sampling points by calculating adifference between incoming beam strength and tissue absorption andadjusting for reflection.

Preferably, ultrasound image quality at a plurality of positions isestimated to determine a position with the highest imaging quality.Additionally, image quality at a position may be calculated over a timeperiod to determine how the image quality changes with a respiratoryand/or a heartbeat motion of the patient. In some embodiments, where theestimated ultrasound velocity along the route from the position to thetarget can be assumed to not change over the time period, distortion inacquired ultrasound images may be compensated for by a constant gainfactor and a constant offset factor. In other situations where theestimated ultrasound velocity along the route from the position to thetarget varies over the time cycle, distortion in acquired ultrasoundimages may be compensated for by a dynamic gain factor and a constantoffset factor. The dynamic gain factor and offset factor may becalculated from static errors for two or more time steps in the timeperiod of acquired anatomical site image data.

In some embodiments, the image quality estimates may be displayedrelative to a three dimensional model of a tissue surface of theanatomical site. Indications may be provided for the estimated imagingquality at each of the positions analyzed. Optionally, the method mayinclude acquiring second image data of the anatomical site including thetarget at discrete intervals and compensating for a distortion inacquired ultrasound image data using the second imaging data of theanatomical site.

In other embodiments of the invention, a system for estimatingultrasound image quality at a variety of positions to determine adesired ultrasound transducer position is provided. The system includesan input module configured to receive anatomical image data from a firstimaging modality and an image quality estimation module coupled with theinput module. The image quality estimation module may be configured toestimate ultrasound image quality when imaging the target at a positionrelative to the target by analyzing the acquired image data to estimateultrasound velocity along a route from the position to the target. Thesystem may include a display module coupled with the image qualityestimation module and configured to output an indication of theultrasound image quality at positions relative to the target to theuser.

The received image data may comprise CT image data and the route may beevaluated by the image quality estimation module by classifying theroute tissue types based on their CT intensity values. The image qualityestimation module may be configured to virtually propagate an ultrasoundbeam along the route and through the one or more tissue types using aray casting method and may estimate ultrasound transmission at discretesampling points by calculating a difference between incoming beamstrength and tissue absorption and adjusting for reflection. The imagequality estimation module may be configured to estimate ultrasound imagequality over a time period. Further the input module may be configuredto receive ultrasound image data and the system may include a signalprocessing module coupled with the input module. The signal processingmodule may compensate for distortion in the ultrasound images by aconstant or dynamic gain factor and a constant or dynamic offset factor.The signal processing module may use the constant gain factor and theconstant offset factor when the estimated ultrasound velocity along theroute from the position to the target is assumed to not change over thetime period. Alternatively, the signal processing module may use thedynamic gain factor and the dynamic offset factor when the estimatedultrasound velocity along the route from the position to the targetvaries over the time period. The output of the display module mayinclude a three dimensional model of a surface of the anatomical sitewith color indications corresponding to estimated ultrasound imagequality at positions on the three dimensional model.

Further features of the invention, its nature and various advantageswill be more apparent from the accompanying drawings and the followingdetailed description.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates an exemplary method of taking ultrasound imagesaccording to embodiments of the invention;

FIG. 2 illustrates an exemplary method of estimating ultrasound imagequality according to embodiments of the invention;

FIG. 3 provides an exemplary table mapping Hounsfield values to acousticproperties;

FIG. 4 illustrates an exemplary method of estimating ultrasound imagequality according to embodiments of the invention;

FIGS. 5A-5B illustrate a display of the output of ultrasound imagequality estimates calculated according to methods of the presentinvention relative to preferred ultrasound transducer positionsidentified by an ultrasound technician;

FIG. 6 illustrates a display of the output of ultrasound image qualityestimates calculated according to methods of the present invention forimaging the substantia nigra;

FIGS. 7A-7E illustrate optimal windows for visualizing the RUPV fordifferent patients according to methods of the present invention;

FIG. 8 illustrates optimal windows for visualizing the septum for eighttime steps according to methods of the present invention;

FIG. 9 illustrates a situation where estimated ultrasound velocity alonga route from the ultrasound transducer position to the target may varyover time;

FIG. 10 illustrates a situation where estimated ultrasound velocityalong a route from the ultrasound transducer position to the targetstays relatively constant over time;

FIG. 11 illustrates an exemplary method of compensating for distortionin ultrasound image data;

FIG. 12 illustrates a first motion curve fitted to ultrasound datarelative to a second motion curve fitted to intermittently acquiredimage data from another imaging modality;

FIG. 13 illustrates an exemplary method of extrapolating target positionbased on past tissue motion; and

FIG. 14 illustrates a system for estimating ultrasound image quality atvarious positions and/or compensating for distortions in ultrasoundimage data.

DETAILED DESCRIPTION OF THE INVENTION

The present invention generally provides improved devices, systems, andmethods for ultrasound tracking of tissue. The invention is particularlywell suited for tracking of moving tissues such as tissues of the heartand tissue structures adjacent the heart that move with the cardiac orheartbeat cycles. The invention may take advantage of radiosurgicalstructures and methods which have been developed for treating tumors,particularly those which are associated with treatments of tissuestructures that move with the respiration cycle. The systems and methodsdisclosed herein may be used to continuously track movement of apatient's heart during radiosurgical examinations for example. Thecardiac cycle is typically considerably faster than the respirationcycle. The overall treatment times can also be quite lengthy foreffective radiosurgical procedures on the heart (typically being greaterthan 10 minutes, often being greater than ½ hour, and in many cases,being two hours or more). Hence, it will often be advantageous to avoidcontinuous imaging of the target and adjacent tissues using fluoroscopyor the like. A variety of differing embodiments may be employed, withthe following description presenting exemplary embodiments that do notnecessarily limit the scope of the invention.

FIG. 1 illustrates an exemplary method 10 of estimating ultrasound imagequality at ultrasound positions relative to a target. At step 12,pre-treatment images of the target are acquired, typically over a timeperiod. At step 14, the pre-treatment images may be used to estimateimage quality of an ultrasound transducer at various positions relativeto a target. The image quality may be estimated over the time period. Atstep 16, the image quality estimates for one or more positions may bedisplayed to an operator, preferably relative to a three-dimensionalsurface model of the patient. At step 18, a desired transducer positionmay be identified which has a high estimated image quality. The desiredtransducer position may have the highest averaged image quality over agiven time period. At step 20, ultrasound velocity along the route fromthe desired transducer position to the target may be analyzed todetermine whether the ultrasound velocity along the route staysrelatively constant or whether it varies with time. At step 22,ultrasound images of the target may be acquired from the desiredposition. At step 24, distortion in the ultrasound images may becompensated for using a gain and offset factor calculated from theinformation obtained in step 20. Advantageously, an ultrasound operatormay be able to quickly identify and visualize the optimal positions foran ultrasound transducer prior to imaging a target by utilizing thedisclosed method. Further, the ultrasound operator may be able tovisualize how the image quality may change from a plurality of positionswith patient movement from a respiratory motion and/or a heartbeatmotion. Moreover, distortions in the acquired ultrasound images may becompensated by using the methods disclosed herein.

The pre-treatment image data acquired 12 include the anatomical site andthe target tissue. The image data may be a two dimensional single CTscan or a three dimensional CT scan. Further the pre-treatment imagedata may be acquired over a time period in order to capture anatomicalsite and target movement during a heartbeat cycle and/or a respiratorycycle motion of the patient. These scans may also be used for thecontouring of the target region and the calculation of the dosedistribution during radiosurgical treatment planning. The scans may comefrom other imaging modalities such as MRI, PET, etc.

FIG. 2 illustrates an exemplary method 26 of estimating the imagequality of a transducer placed at a certain skin position 14. The methodstarts at step 28 by identifying an ultrasound transducer positionrelative to the target in the acquired image data. At step 30, a routefrom the transducer position to a chosen target position inside thevolume is analyzed. At step 32, the ultrasound velocity in tissues alongthe route is estimated. At step 34, an ultrasound beam may be virtuallypropagated from the position and along the route based on a ray castingmethod. At step 36, ultrasound transmission may be estimated at discretesampling points to estimate overall ultrasound image quality.

To estimate the imaging quality of a transducer placed at a certainposition, the route from the transducer position to a chosen targetposition inside the volume must be analyzed. For a good view of thetarget one consideration is the absorption of the ultrasound beamtravelling forth and back between the target and the transducer. Theestimation of beam strength can be calculated based on beam transmissionand reflection as the main parts in beam absorption. FIG. 3 illustratesan exemplary pre-treatment scan 38 of the anatomical site including thetarget 40. A route 42 from a transducer position 44 to the target 40 isdetermined. The tissues which the route 42 passes through can bedetermined from the pre-treatment image data. Tissue types may beclassified by using the acquired pre-treatment image data. For example,where the pre-treatment data is one or more CT scans, the tissue typesmay be classified with respect to their CT intensity values. FIG. 4provides an overview of tissue in the region of the heart and theircorresponding Hounsfield units. The exemplary route 42 illustrated inFIG. 3, passes through skin 46, fat 48, and muscle 50 in order to arriveat target 40 from the transducer position 44. Afterwards, the ultrasoundbeam is virtually propagated through the CT volume using a ray castingmethod. For every discrete sampling point 52, the ultrasoundtransmission is calculated as a difference of incoming beam strength andtissue absorption. The reflection may be calculated by:

$\begin{matrix}{R = {\left( {Z_{2} - Z_{1}} \right)^{2}/\left( {Z_{2} + Z_{1}} \right)^{2}}} & (1)\end{matrix}$

Where Z₁ and Z₂ represent the acoustic impedances at the current andprevious sampling point, is additionally subtracted. Given all possibletransducer positions 44 on the patient's chest, a desired ultrasoundtransducer position maximizes the ultrasound transmission betweentransducer and target. In some embodiments, the target visibility overtime may be calculated where the desired position is computed as theweighted maximum visibility over all time steps of a 4DCT. Additionally,embodiments may take advantage of enhanced beam strength computation byadjusting for interference, refraction, diffraction and beam diffusion.Further, methods may include additional visibility analysis by analyzingtarget reflection, entropy in target region, and complete ultrasoundimage simulation. The methods may take a simulated ultrasound image anddetect, at which quality the target is visualized inside. The easiestway to do it may be to accumulate the brightness in this area. Anenhanced method may be to measure the entropy or the amount ofedges/intensity gradients inside the image. All gradients could besummed to one value indicating the image quality.

After image quality estimation 14, the results may be displayed to anoperator 16. Preferably, a plurality of image quality estimations 14 arecalculated according to the methods disclosed herein. Indications of theimage quality at each position may inform an operator which positionsare best for imaging a target using an ultrasound transducer. In apreferred embodiment, the indications of image quality are displayedrelative to a three dimensional model of the patient. The image qualityindications may comprise a color coding on the three dimensional model.For example, FIG. 5A displays the computed image quality of transducerpositions according to methods of the present invention. As shown inFIG. 5A, a three-dimensional model 54 of the patient can be constructedfrom the pre-treatment image data. The blue indications 56 on thethree-dimensional model indicate positions which have high estimatedimage quality. FIG. 5B shows the ultrasound windows as determined by aradiologist. The positive windows 58 illustrate the preferred windowsfor measuring the target tissue while the negative windows 60 illustrateundesired windows. As can be appreciated from FIGS. 5A and 5B, themethods of estimating ultrasound image quality prior to imagingdisclosed herein correspond to the positive windows 58 which weredetermined by the radiologist. It may be worth noting that positivewindow 62 which was added by the radiologist required a lot of pressureto obtain a reasonable image and accordingly, the ultrasound imagequality estimation did not include a corresponding positive window.

FIG. 6 illustrates another exemplary display of image quality estimatesas determined by methods disclosed herein. The high quality windows forimaging the substantia nigra is displayed. This type of imaging mayprovide for the early detection of Parkinson's disease. FIGS. 7A-7Eillustrate the optimal viewing windows for visualizing the RUPV fordifferent patients as computed by the methods disclosed herein.

As discussed above, image quality estimation may be performed for aplurality of time steps to indicate how image quality may change with apatient respiratory and/or heart beat motion. FIG. 8 illustrates theoptimal windows for visualizing the septum over eight time steps. Theoptimal windows may vary slightly over the eight time steps. Imagequality may also be estimated at varying frequencies as needed. Forexample, the quality may be estimated at higher frequencies for targettissues which have fast tissue movements such as the heart. Imagequality may be estimated at lower frequencies for tissues whichrelatively slower motions. Accordingly, the operator may choose atransducer position with the highest average image quality over the timeperiod for visualizing a target tissue.

After estimating the ultrasound image quality at one or more positions14, steps maybe taken to minimalize distortion or to compensate fordistortion in any acquired ultrasound images. The distance in ultrasoundscans may be computed as:

$\begin{matrix}{{Distance} = {{Time}*{Velocity}}} & (2)\end{matrix}$

This ultrasound velocity cannot be measured by the ultrasound transducerand is commonly approximated by 1540 m is as a mean speed of sound forthe penetrated tissue. While this maybe a good approximation forvisualization, it theoretically allows for errors of up to five percentin the distance calculation. In a worst-case scenario, a target at adistance of 150 mm may be distorted in forth/back direction by up to 7.5mmm including an uncertainty of 15 mm. While the theoretical error isrelatively unlikely, distortions of up to two percent (e.g., 3 mm at 150mm distance) are commonly present.

In some embodiments, distortions can be derived from the pre-treatmentimage data, such as a CT volume, and used for compensation. Preferably,an optimization of the transducer position may be used as an a prioristrategy to minimize the expected velocity changes and the necessity todynamically correct for them.

As seen above, tissue ultrasound properties can be estimated based onacquired pre-treatment data. For example, when pre-treatment datacomprises CT image data, ultrasound properties can be sufficientlymapped to CT Hounsfield units for a particular anatomical region. Anultrasound transducer may be virtually placed at the skin surface andthe acoustic properties including velocity differences can be computedfrom CT data. Assuming constant velocity errors between transducer andtarget, a simple function using the two compensation factors, Gain andOffset can be applied to correct for distortions:

$\begin{matrix}{{{Corrected}\mspace{14mu}{distance}} = {f\mspace{11mu}\left( {{Distance},{Gain},{Offset}} \right)}} & (3)\end{matrix}$

The distortion of the relative target movement may be low and may beneglected. The gain and offset may be calculated with the provided setof two corresponding positions/distances in ultrasound and a secondarymodality. Then a function may be used to linearly undistort theultrasound volume:

real_distance=f(ultrasound_distance)=offset+gain*ultrasound_distance.  (4)

In situations with time-varying errors due to non-uniform movements inthe beam path, the absolute and even the relative target movements canbe compensated. FIG. 9 illustrates a situation where a movement alongthe beam path induces a non-existing target movement in the distancemeasurements. Ultrasound transducer 64 may be imaging target 66 from aroute 68. Route 68 passes through a tissue 70 which moves during apatient's respiration and/or heartbeat motion. Accordingly, even thoughtarget 66 is static, the measured target distance 72 may vary over timedue to the motion of tissue 70.

The quality of the compensation depends on the available data. In thecase of only one CT volume, static distortions may be compensated forquite well. Error sources may include errors from mapping ultrasoundproperties according to CT Hounsfield units and ultrasound modelcomplexity. Compensation for static error can include a measurement ofstatic errors using the CT image data and a static offset and gaincompensation. Resulting image quality may be very good. In situationswhere the target is moving, it is preferable to have a series ofpre-treatment scans available to compensate for errors. It may bedifficult to calculate for distortion since target motion is unknownwith only a single CT volume. In situations where only a single CTvolume is available, a statistical approach may be used to compensatefor distortion. Alternatively, the assumption of the common meanultrasound velocity may be used. When 4DCT data is available, errorsources may include errors from mapping ultrasound properties accordingto CT Hounsfield units and ultrasound model complexity. A further errorsource may be introduced in the identification of the current time step.Error may be compensated by a measurement of static errors over all timesteps. Thereafter, a dynamic gain and offset compensation may becalculated to reduce distortions due to respiratory and/or cardiacmotion. Accordingly, ultrasound image data distortion may be compensatedwhen the target is static or when the target is in motion by using theacquired pre-treatment data.

Another method of minimizing distortion in ultrasound transducer imagedata comprises minimizing the distance between the ultrasound transducerand the target. The distance may be simply added as a factor into thequality function of the search algorithm given above.

$\begin{matrix}{{{Position}\mspace{14mu}{quality}} = {{a*{Transmission}} + {b*{Distance}}}} & (5)\end{matrix}$

When 4DCT data is available, minimizing distortion may include measuringthe absolute distortion or the distortion change (combined with staticdistortion correction) overtime for every possible transducer positionand minimize them in order to find an optimal transducer position.

$\begin{matrix}{{{Position}\mspace{14mu}{quality}} = {{a*{transmission}} + {b*{Distortion}\mspace{14mu}{Change}}}} & (6)\end{matrix}$

When CT image data of a single time step is available, transducerpositions where tissue velocities are similar for a cylindrical volumearound the beam path may be preferred. FIG. 10 illustrates such anexample. In this situation, transducer 74 may be imaging target 76 alongroute 78. A tissue 80 with a different ultrasound property may have amotion associated with patient respiratory or heartbeat motion, howeverthe tissue 80 and its motion may be disposed outside of a securityregion 82. Accordingly, the transducer position may be selected to makeit less likely that tissue with different velocity properties enters thebeam path and induces time-varying distortions. Thus the methodsdisclosed herein may be used to select ultrasound transducer positionswhich limit the amount of distortion in image data by limiting thechances of a time-varying ultrasound velocity along the ultrasoundtransducer route.

As discussed above, the methods disclosed above may be used to tracktarget tissues during radiosurgical treatments and systems such as thosedisclosed in related U.S. patent application Ser. No. 11/971,399entitled Depositing Radiation in Heart Muscle under Ultrasound Guidance,the entire disclosure of which is incorporated herein by reference. Astereotaxic radiation treatment device typically includes a beamingdevice, which is also called the beam source. This beam source producesa beam of radiation. The beam source can be moved to differentlocations. In this way, the beam can be directed towards the target.Targets are typically tumors, but other lesions can also be treated withthis method. In commercially available systems for radiosurgery, thebeam source is mounted to a robotic arm. This arm is freelyprogrammable, and can move the beam source to appropriate locations inspace. It can also move the beam source in such a way that the beamtracks the motion of a moving target. The motion of the target occurswhen the tumor is close to the heart or the lung, and is due to theheartbeat or the respiratory motion of the patient's chest. Prior totreatment, a CT or an MR may be taken from the anatomical site/region ofinterest. The target is then marked in the resulting stack of images ormay be marked relative to a three-dimensional image model of the targetregion according to the methods and systems disclosed in relatedapplication Ser. No. 12/838,308 entitled Heart Tissue SurfaceContour-Based Radiosurgical Treatment Planning, the entire disclosure ofwhich is incorporated herein by reference.

Radiosurgical systems typically track target tissue using a bi-planarx-ray system, however there are advantages of reducing the amount ofpatient exposure to radiation. While ultrasound tracking of targettissues has been proposed, distortion in ultrasound image data may makesuch tracking insufficient since target tracking during radiosurgicaltreatments must be very accurate, especially for target tissues, such asheart tissues, which move relatively rapidly with patient respirationmotion and/or heartbeat motion.

FIG. 11 illustrates another method 84 of reducing distortions inacquired ultrasound imaging data and/or for tracking target tissuesduring a radiosurgical procedure. At step 86, markers may be implantedat or adjacent to the target tissue if the target tissue cannot beeasily distinguished in imaging data. At step 88, the position of thetarget tissue is determined using a first imaging modality to image thetarget tissue and/or the implanted markers at discrete intervals. Atstep 90, the position of the target tissue is determined using anultrasound imaging device to image the target tissue and/or theimplanted markers to provide a continuous stream of imaging data. Atstep 92, a first curve is fitted to the target tissue position data atthe discrete intervals as determined by the first imaging modality. Atstep 94, a second curve is fitted to the target tissue position data asdetermined by the ultrasound imaging device. At step 96, the first curveand the second curve are overlaid to obtain a single curve. At step 98,distortion in the ultrasound image data may be subtracted based on thedeformation of the ultrasound curve from the overlaying of the twocurves. At step 100, current positions of the target tissue may beextrapolated based on past motion during times of poor ultrasoundimaging.

In some methods of the present invention, markers may be implanted neara target 86. These markers may be, for example, gold markers which areimplanted in or near a target tissue. The markers may be used to betteridentify a target tissue in subsequently captured images. The exactposition of the target tissue and/or implanted markers may be determinedby a first imaging modality 88. The first imaging modality may be astereo x-ray imaging system which typically accompanies radiosurgicalsystems. Continuous imaging is discouraged due to radiation exposure ofthe patient and technical limitations of the x-ray imaging systemsavailable commercially. The acquisition of images with the stereo x-rayimaging system may be repeated several times before treatment. Thisgives a series of exact positions of the target obtained with x-rayimaging. However, this series may not be continuous and may not presentreal-time information on the target location. Accordingly, theultrasound camera may be used to yield a continuous stream of images 90,where each image has the target located. As discussed above, the targetlocation may be identified with high speed automatically by using atemplate matching algorithm. This stream may contain more than 20 imagesper second.

A first curve may be fitted to the position data obtained by the stereox-ray imaging system 92 and a second curve may be fitted to the positiondata acquired by the ultrasound image data 94. Since the second curve isobtained with ultrasound, it will be subject to distortion. The firstsuch curve is free of distortion. After fitting the first and secondcurves to the acquired position data, the two curves are overlaid toobtain a single undistorted curve 96 with points sufficiently denselyspaced along the curve such that real-time tracking of the target ispossible.

FIG. 12 illustrates the two curves representing position information forthe target. For example, each curve can represent the motion of thetarget along the x-axis of the base coordinate system used for thetreatment. The curve 102 shows the distorted curve of target positionsobtained from analyzing the ultrasound images. The curve 104 may not befully known during treatment, and only a small number of positions 106along this curve are known. Since both curves must show the same motion,they can be aligned. After alignment, the ultrasound curve 102 isdeformed in such a way that the points 106 will closely match the curve104. The deformation thus obtained is then expressed as a function andcan be used to obtain undistorted position information 98 for the newultrasound images received after switching of the x-ray imaging device.An ultrasound image may be acquired along the beam path from transducerto target and back. Distortions may be mostly caused by differences ofthe speed of sound in different tissue. This may be a non-lineardistortion along the beam path and (to have the best fitting) anon-linear function:

f(ultrasound_distance)=real_distance  (7)

has to be found for undistortion. This may be a table, which can beapproximated by a polynomial function.

An ultrasound imaging camera must be placed in a position with goodvisibility on the patient's skin surface. In a preferred embodiment ofthe present invention, the method includes obtaining an optimalplacement of the ultrasound camera 10. As discussed above, a simulationof the physical properties of the ultrasound imaging device is used.This simulation may rely on the CT or MR data obtained before treatment.

In another preferred embodiment in accordance with the presentinvention, the past curve of the motion obtained with the ultrasoundsystem is used to extrapolate current and future positions 100. This maybe done to overcome periods of poor visibility in the ultrasound image.FIG. 13 shows several positions of a target as seen in an ultrasoundimage. In each image, the target occurs shifted, either in vertical orhorizontal direction. A template may be delineated by the user in thefirst image 108. Cross correlation is used to compute the shiftingoffsets 110 and 112 for obtaining the new position of the target.

In a further embodiment of the invention, the x-ray imaging system isused to locate small markers attached to the ultrasound camera. In thisway, the relative positions of the ultrasound camera can be computed inthe same coordinate system as that of the treatment device.

FIG. 14 illustrates a system 114 for compensating for distortions inultrasound images. The system 114 may include an input module 116 forreceiving: 1) pre-treatment images of an anatomical site including thetarget from a pre-treatment imaging modality 118; 2) ultrasound imagesof the anatomical site including the target from an ultrasound imagingmodality 120; and 3) in-treatment images of the anatomical siteincluding the target from an in-treatment imaging modality 122. An imagequality estimation module 124 may be coupled with the input module 116for estimating ultrasound image quality at various positions relative tothe target. A signal processing module 126 may be coupled to the inputmodule 116 for adjusting for distortions in acquired ultrasound imagedata by using acquired pre-treatment image data or in-treatment imagedata. The output from the image quality estimation module 124 and thesignal processing module 126 may be displayed to an operator by using acoupled display module 128. In a preferred embodiment, system 114includes an extrapolation module 130 for calculated current or futuretarget position based on past target motion.

The image quality estimation module 124 may use acquired pretreatmentimages of the anatomical site to estimate ultrasound image quality at aplurality of positions to determine a desired ultrasound transducer. Theimage quality estimation 124 module may estimate image quality over atime period, such as a time period over a patient respiratory motionand/or heartbeat motion. The signal processing module 126 may beconfigured to compensate for distortions in acquired ultrasound imagedata by using methods disclosed herein and acquired pre-treatment imagesof the target area or acquired in-treatment image data, such as stereox-ray images. The display module 128 may be configured to output theultrasound image quality estimates relative to a three dimensional modelof the patient.

While the exemplary embodiments have been described in some detail, byway of example and for clarity of understanding, those of skill in theart will recognize that a variety of modification, adaptations, andchanges may be employed. Hence, the scope of the present inventionshould be limited solely by the appending claims.

The embodiments discussed herein are illustrative. As these embodimentsare described with reference to illustrations, various modifications oradaptations of the methods and/or specific structures described maybecome apparent to those skilled in the art after reading the abovedisclosure.

In the foregoing specification, the invention is described withreference to specific embodiments thereof, but those skilled in the artwill recognize that the invention is not limited thereto. Variousfeatures and aspects of the above-described invention can be usedindividually or jointly. Further, the invention can be utilized in anynumber of environments and applications beyond those described hereinwithout departing from the broader spirit and scope of thespecification. The specification and drawings are, accordingly, to beregarded as illustrative rather than restrictive. It will be recognizedthat the terms “comprising,” “including,” and “having,” as used herein,are specifically intended to be read as open-ended terms of art.

What is claimed is:
 1. A system for estimating ultrasound image qualityat a variety of positions to determine a desired ultrasound transducerposition, the system comprising: an input module configured to receiveanatomical image data from a first imaging modality, the anatomicalimage data including a target; an image quality estimation modulecoupled to the input module, the image quality estimation moduleconfigured to estimate ultrasound image quality when imaging the targetat a position relative to the target by analyzing the acquired imagedata to estimate ultrasound velocity along a route from the position tothe target, the route passing through one or more tissue types; and adisplay module coupled with the image quality estimation module, thedisplay module configured to output an indication of the ultrasoundimage quality at positions relative to the target to the user.
 2. Thesystem of claim 1, wherein the received image data comprises CT imagedata, and wherein the route is evaluated by the image quality estimationmodule by classifying the route tissue types based on their CT intensityvalues.
 3. The system of claim 2, wherein the image quality estimationmodule virtually propagates an ultrasound beam along the route andthrough the one or more tissue types using a ray casting method andestimates ultrasound transmission at discrete sampling points bycalculating a different between incoming beam strength and tissueabsorption and adjusting for reflection.
 4. The system of claim 1,wherein the image quality estimation module is configured to estimateultrasound image quality over a time period.
 5. The system of claim 4,wherein the input module is further configured to receive ultrasoundimage data, and the system further comprises a signal processing modulecoupled with the input module, the signal processing module configuredto compensate for distortion in the ultrasound images by a constant ordynamic gain factor and a constant or dynamic offset factor.
 6. Thesystem of claim 5, wherein the signal processing module is configured touse the constant gain factor and the constant offset factor when theestimated ultrasound velocity along the route from the position to thetarget is assumed to not change over the time period.
 7. The system ofclaim 5, wherein the signal processing module is configured to use thedynamic gain factor and the dynamic offset factor when the estimatedultrasound velocity along the route from the position to the targetvaries over the time period.
 8. The system of claim 1, wherein theoutput of the display module comprises a three dimensional model of asurface of the anatomical site with color variations.
 9. The system ofclaim 1, wherein: the received image data comprises CT image data; theroute is evaluated by the image quality estimation module by classifyingthe route tissue types based on their CT intensity values; and the imagequality estimation module virtually propagates an ultrasound beam alongthe route and through the one or more tissue types using a ray castingmethod and estimates ultrasound transmission at discrete sampling pointsby calculating a difference between incoming beam strength and tissueabsorption and adjusting for reflection.
 10. An ultrasound tissueimaging system comprising: an ultrasound image sensor to generateultrasound data of a target included within or adjacent to an anatomicalsite; an input for receiving other image data regarding the anatomicalsite from another imaging modality; a processor configured to generateultrasound image correction data of the anatomical site from the otherimage data to compensate for distortion of the ultrasound data; and animage or measurement output coupled to the processor for communicationof an ultrasound measurement or image of the target in response to thecorrection data.
 11. The system of claim 10, wherein the other imagedata comprises CT image data.
 12. The system of claim 10, wherein theanother imaging modality comprises a bi-plane x-ray imaging modality.13. The system of claim 10, wherein the anatomical site is a heart. 14.The system of claim 10, wherein the ultrasound image correction data isgenerated less frequently than the ultrasound data.
 15. The system ofclaim 10, wherein the processor generates the ultrasound imagecorrection data by observing a time sequence of positions of the targetusing the another imaging modality.
 16. The system of claim 15, whereinthe processor develops a first motion curve of the target from theultrasound data and a second motion curve of the target from the anotherimaging modality.
 17. The system of claim 16, wherein the processor isfurther configured to deform the first motion curve by overlaying thefirst motion curve with the second motion curve and compute thedistortion in the ultrasound data based on a deformation of the firstcurve.
 18. The system of claim 17, wherein the processor is furtherconfigured to subtract the distortion from the ultrasound data.
 19. Thesystem of claim 1, wherein the processor is further configured toextrapolate in-treatment position of the target based on pastobservations.
 20. The system of claim 1, wherein the ultrasoundmeasurement or image of the target comprises a three dimensional modelof a surface of the anatomical site with color variations.